Textbook of Medical Physiology; with STUDENT CONSULT Access

by Guyton & Hall

• ISBN13: 9780721602400
• ISBN10: 0721602401
• Edition: 11th
• Format: Hardcover
• Copyright: 2005-06-30
• Publisher: SAUNDERS W B CO

Summary

Physiology's classic text continues to uphold its rich tradition-presenting key physiology concepts in a remarkably clear and engaging manner. Guyton & Hall's Textbook of Medical Physiology covers all of the major systems in the human body, while emphasizing system interaction, homeostasis, and pathophysiology. This very readable, easy-to-follow, and thoroughly updated, 11th Edition features a new full-color layout, short chapters, clinical vignettes, and shaded summary tables that allow for easy comprehension of the material. The smart way to study! Elsevier titles with STUDENT CONSULT will help you master difficult concepts and study more efficiently in print and online! Perform rapid searches. Integrate bonus content from other disciplines. Download text to your handheld device. And a lot more. Each STUDENT CONSULT title comes with full text online, a unique image library, case studies, USMLE style questions, and online note-taking to enhance your learning experience. Presents short, easy-to-read chapters in keeping with the Guyton and Hall tradition. Provides shaded summary tables for easy reference. Includes clinical vignettes, which allow readers to see core concepts applied to real-life situations. Offers specific discussions of pathophysiology in most clinical areas of medicine. Ensures a strong grasp of physiology concepts through well-illustrated discussions of the most essential principles. Now in full color! Offers access to the full text and other valuable features online via the STUDENT CONSULT website. Uses full-color illustrations throughout, including 486 figures, 277 charts and graphs, 100 brand-new line drawings, and 36 ECGs. Features a new full-color design that makes information more engaging and even easier to read. Updated throughout to reflect the latest knowledge in the field.

Table of Contents

UNIT I Introduction to Physiology: The Cell and General Physiology
Functional Organization of the Human Body and Control of the ``Internal Environment''	3	(8)
Cells as the Living Units of the Body	3	(1)
Extracellular Fluid---The ``Internal Environment''	3	(1)
``Homeostatic'' Mechanisms of the Major Functional Systems	4	(2)
Homeostasis	4	(1)
Extracellular Fluid Transport and Mixing System---The Blood Circulatory System	4	(1)
Origin of Nutrients in the Extracellular Fluid	5	(1)
Removal of Metabolic End Products	5	(1)
Regulation of Body Functions	5	(1)
Reproduction	6	(1)
Control Systems of the Body	6	(3)
Examples of Control Mechanisms	6	(1)
Characteristics of Control Systems	7	(2)
Summary---Automaticity of the Body	9	(2)
The Cell and Its Functions	11	(16)
Organization of the Cell	11	(1)
Physical Structure of the Cell	12	(6)
Membranous Structures of the Cell	12	(2)
Cytoplasm and Its Organelles	14	(3)
Nucleus	17	(1)
Nuclear Membrane	17	(1)
Nucleoli and Formation of Ribosomes	18	(1)
Comparison of the Animal Cell with Precellular Forms of Life	18	(1)
Functional Systems of the Cell	19	(5)
Ingestion by the Cell---Endocytosis	19	(1)
Digestion of Pinocytotic and Phagocytic Foreign Substances Inside the Cell---Function of the Lysosomes	20	(1)
Synthesis and Formation of Cellular Structures by Endoplasmic Reticulum and Golgi Apparatus	20	(2)
Extraction of Energy from Nutrients---Function of the Mitochondria	22	(2)
Locomotion of Cells	24	(3)
Ameboid Movement	24	(1)
Cilia and Ciliary Movement	24	(3)
Genetic Control of Protein Synthesis, Cell Function, and Cell Reproduction	27	(18)
Genes in the Cell Nucleus	27	(3)
Genetic Code	29	(1)
The DNA Code in the Cell Nucleus Is Transferred to an RNA Code in the Cell Cytoplasm---The Process of Transcription	30	(5)
Synthesis of RNA	30	(1)
Assembly of the RNA Chain from Activated Nucleotides Using the DNA Strand as a Template---The Process of ``Transcription''	31	(1)
Messenger RNA---The Codons	31	(1)
Transfer RNA---The Anticodons	32	(1)
Ribosomal RNA	33	(1)
Formation of Proteins on the Ribosomes---The Process of ``Translation''	33	(2)
Synthesis of Other Substances in the Cell	35	(1)
Control of Gene Function and Biochemical Activity in Cells	35	(2)
Genetic Regulation	35	(1)
Control of Intracellular Function by Enzyme Regulation	36	(1)
The DNA-Genetic System Also Controls Cell Reproduction	37	(3)
Cell Reproduction Begins with Replication of DNA	37	(1)
Chromosomes and Their Replication	38	(1)
Cell Mitosis	38	(1)
Control of Cell Growth and Cell Reproduction	39	(1)
Cell Differentiation	40	(1)
Apoptosis---Programmed Cell Death	40	(1)
Cancer	40	(5)
UNIT II Membrane Physiology, Nerve, and Muscle
Transport of Substances Through the Cell Membrane	45	(12)
The Lipid Barrier of the Cell Membrane, and Cell Membrane Transport Proteins	45	(1)
Diffusion	46	(6)
Diffusion Through the Cell Membrane	46	(1)
Diffusion Through Protein Channels, and ``Gating'' of These Channels	47	(2)
Facilitated Diffusion	49	(1)
Factors That Affect Net Rate of Diffusion	50	(1)
Osmosis Across Selectively Permeable Membranes---``Net Diffusion'' of Water	51	(1)
``Active Transport'' of Substances Through Membranes	52	(5)
Primary Active Transport	53	(1)
Secondary Active Transport---Co-Transport and Counter-Transport	54	(1)
Active Transport Through Cellular Sheets	55	(2)
Membrane Potentials and Action Potentials	57	(15)
Basic Physics of Membrane Potentials	57	(1)
Membrane Potentials Caused by Diffusion	57	(1)
Measuring the Membrane Potential	58	(1)
Resting Membrane Potential of Nerves	59	(2)
Origin of the Normal Resting Membrane Potential	60	(1)
Nerve Action Potential	61	(3)
Voltage-Gated Sodium and Potassium Channels	62	(2)
Summary of the Events That Cause the Action Potential	64	(1)
Roles of Other Ions During the Action Potential	64	(1)
Initiation of the Action Potential	65	(1)
Propagation of the Action Potential	65	(1)
Re-establishing Sodium and Potassium Ionic Gradients After Action Potentials Are Completed---Importance of Energy Metabolism	66	(1)
Plateau in Some Action Potentials	66	(1)
Rhythmicity of Some Excitable Tissues---Repetitive Discharge	67	(1)
Special Characteristics of Signal Transmission in Nerve Trunks	68	(1)
Excitation---The Process of Eliciting the Action Potential	69	(1)
``Refractory Period'' After an Action Potential	70	(1)
Recording Membrane Potentials and Action Potentials	70	(2)
Inhibition of Excitability---``Stabilizers'' and Local Anesthetics	70	(2)
Contraction of Skeletal Muscle	72	(13)
Physiologic Anatomy of Skeletal Muscle	72	(2)
Skeletal Muscle Fiber	72	(2)
General Mechanism of Muscle Contraction	74	(1)
Molecular Mechanism of Muscle Contraction	74	(4)
Molecular Characteristics of the Contractile Filaments	75	(2)
Effect of Amount of Actin and Myosin Filament Overlap on Tension Developed by the Contracting Muscle	77	(1)
Relation of Velocity of Contraction to Load	78	(1)
Energetics of Muscle Contraction	78	(2)
Work Output During Muscle Contraction	78	(1)
Sources of Energy for Muscle Contraction	79	(1)
Characteristics of Whole Muscle Contraction	80	(5)
Mechanics of Skeletal Muscle Contraction	81	(1)
Remodeling of Muscle to Match Function	82	(1)
Rigor Mortis	83	(2)
Excitation of Skeletal Muscle: Neuromuscular Transmission and Excitation-Contraction Coupling	85	(7)
Transmission of Impulses from Nerve Endings to Skeletal Muscle Fibers: The Neuromuscular Junction	85	(3)
Secretion of Acetylcholine by the Nerve Terminals	85	(3)
Molecular Biology of Acetyline Formation and Release	88	(1)
Drugs That Enhance or Block Transmission at the Neuromuscular Junction	88	(1)
Myasthenia Gravis	89	(1)
Muscle Action Potential	89	(1)
Spread of the Action Potential to the Interior of the Muscle Fiber by Way of ``Transverse Tubules''	89	(1)
Excitation-Contraction Coupling	89	(3)
Transverse Tubule-Sarcoplasmic Reticulum System	89	(1)
Release of Calcium Ions by the Sarcoplasmic Reticulum	90	(2)
Contraction and Excitation of Smooth Muscle	92	(11)
Contraction of Smooth Muscle	92	(3)
Types of Smooth Muscle	92	(1)
Contractile Mechanism in Smooth Muscle	93	(2)
Regulation of Contraction by Calcium Ions	95	(1)
Nervous and Hormonal Control of Smooth Muscle Contraction	95	(8)
Neuromuscular Junctions of Smooth Muscle	95	(1)
Membrane Potentials and Action Potentials in Smooth Muscle	96	(2)
Effect of Local Tissue Factors and Hormones to Cause Smooth Muscle Contraction Without Action Potentials	98	(1)
Source of Calcium Ions That Cause Contraction (1) Through the Cell Membrane and (2) from the Sarcoplasmic Reticulum	99	(4)
UNIT III The Heart
Heart Muscle; The Heart as a Pump and Function of the Heart Valves	103	(13)
Physiology of Cardiac Muscle	103	(3)
Physiologic Anatomy of Cardiac Muscle	103	(1)
Action Potentials in Cardiac Muscle	104	(2)
The Cardiac Cycle	106	(3)
Diastole and Systole	106	(1)
Relationship of the Electrocardiogram to the Cardiac Cycle	107	(1)
Function of the Atria as Primer Pumps	107	(1)
Function of the Ventricles as Pumps	108	(1)
Function of the Valves	109	(1)
Aortic Pressure Curve	109	(1)
Relationship of the Heart Sounds to Heart Pumping	109	(1)
Work Output of the Heart	110	(1)
Graphical Analysis of Ventricular Pumping	110	(1)
Chemical Energy Required for Cardiac Contraction: Oxygen Utilization by the Heart	111	(1)
Regulation of Heart Pumping	111	(5)
Intrinsic Regulation of Heart Pumping---The Frank-Starling Mechanism	111	(2)
Effect of Potassium and Calcium Ions on Heart Function	113	(1)
Effect of Temperature on Heart Function	114	(1)
Increasing the Arterial Pressure Load (up to a Limit) Does Not Decrease the Cardiac Output	114	(2)
Rhythmical Excitation of the Heart	116	(7)
Specialized Excitatory and Conductive System of the Heart	116	(4)
Sinus (Sinoatrial) Node	116	(2)
Internodal Pathways and Transmission of the Cardiac Impulse Through the Atria	118	(1)
Atrioventricular Node, and Delay of Impulse Conduction from the Atria to the Ventricles	118	(1)
Rapid Transmission in the Ventricular Purkinje System	119	(1)
Transmission of the Cardiac Impulse in the Ventricular Muscle	119	(1)
Summary of the Spread of the Cardiac Impulse Through the Heart	120	(1)
Control of Excitation and Conduction in the Heart	120	(3)
The Sinus Node as the Pacemaker of the Heart	120	(1)
Role of the Purkinje System in Causing Synchronous Contraction of the Ventricular Muscle	121	(1)
Control of Heart Rhythmicity and Impulse Conduction by the Cardiac Nerves: The Sympathetic and Parasympathetic Nerves	121	(2)
The Normal Electrocardiogram	123	(8)
Characteristics of the Normal Electrocardiogram	123	(3)
Depolarization Waves Versus Repolarization Waves	123	(2)
Relationship of Atrial and Ventricular Contraction to the Waves of the Electrocardiogram	125	(1)
Voltage and Time Calibration of the Electrocardiogram	125	(1)
Methods for Recording Electrocardiograms	126	(1)
Pen Recorder	126	(1)
Flow of Current Around the Heart During the Cardiac Cycle	126	(1)
Recording Electrical Potentials from a Partially Depolarized Mass of Syncytial Cardiac Muscle	126	(1)
Flow of Electrical Currents in the Chest Around the Heart	126	(1)
Electrocardiographic Leads	127	(4)
Three Bipolar Limb Leads	127	(2)
Chest Leads (Precordial Leads)	129	(1)
Augmented Unipolar Limb Leads	129	(2)
Electrocardiographic Interpretation of Cardiac Muscle and Coronary Blood Flow Abnormalities: Vectorial Analysis	131	(16)
Principles of Vectorial Analysis of Electrocardiograms	131	(3)
Use of Vectors to Represent Electrical Potentials	131	(1)
Direction of a Vector is Denoted in Terms of Degrees	131	(1)
Axis for Each Standard Bipolar Lead and Each Unipolar Limb Lead	132	(1)
Vectorial Analysis of Potentials Recorded in Different Leads	133	(1)
Vectorial Analysis of the Normal Electrocardiogram	134	(3)
Vectors That Occur at Successive Intervals During Depolarization of the Ventricles---The QRS Complex	134	(1)
Electrocardiogram During Repolarization---The T Wave	134	(2)
Depolarization of the Atria---The P Wave	136	(1)
Vectorcardiogram	136	(1)
Mean Electrical Axis of the Ventricular QRS---And Its Significance	137	(3)
Determining the Electrical Axis from Standard Lead Electrocardiograms	137	(1)
Abnormal Ventricular Conditions That Cause Axis Deviation	138	(2)
Conditions That Cause Abnormal Voltages of the QRS Complex	140	(1)
Increased Voltage in the Standard Bipolar Limb Leads	140	(1)
Decreased Voltage of the Electrocardiogram	140	(1)
Prolonged and Bizarre Patterns of the QRS Complex	141	(1)
Prolonged QRS Complex as a Result of Cardiac Hypertrophy or Dilatation	141	(1)
Prolonged QRS Complex Resulting from Purkinje System Blocks	141	(1)
Conditions That Cause Bizarre QRS Complexes	141	(1)
Current of Injury	141	(4)
Effect of Current of Injury on the QRS Complex	141	(1)
The J Point---The Zero Reference Potential for Analyzing Current of Injury	142	(1)
Coronary Ischemia as a Cause of Injury Potential	143	(2)
Abnormalities in the T Wave	145	(2)
Effect of Slow Conduction of the Depolarization Wave on the Characteristics of the T Wave	145	(1)
Shortened Depolarization in Portions of the Ventricular Muscle as a Cause of T Wave Abnormalities	145	(2)
Cardiac Arrhythmias and Their Electrocardiographic Interpretation	147	(14)
Abnormal Sinus Rhythms	147	(1)
Tachycardia	147	(1)
Bradycardia	147	(1)
Sinus Arrhythmia	148	(1)
Abnormal Rhythms That Result from Block of Heart Signals Within the Intracardiac Conduction Pathways	148	(2)
Sinoatrial Block	148	(1)
Atrioventricular Block	148	(1)
Incomplete Atrioventricular Heart Block	149	(1)
Incomplete Intraventricular Block---Electrical Alternans	150	(1)
Premature Contractions	150	(1)
Premature Atrial Contractions	150	(1)
A-V Nodal or A-V Bundle Premature Contractions	150	(1)
Premature Ventricular Contractions	151	(1)
Paroxysmal Tachycardia	151	(1)
Atrial Paroxysmal Tachycardia	152	(1)
Ventricular Paroxysmal Tachycardia	152	(1)
Ventricular Fibrillation	152	(3)
Phenomenon of Re-entry---``Circus Movements'' as the Basis for Ventricular Fibrillation	153	(1)
Chain Reaction Mechanism of Fibrillation	153	(1)
Electrocardiogram in Ventricular Fibrillation	154	(1)
Electroshock Defibrillation of the Ventricle	154	(1)
Hand Pumping of the Heart (Cardiopulmonary Resuscitation) as an Aid to Defibrillation	155	(1)
Atrial Fibrillation	155	(1)
Atrial Flutter	156	(1)
Cardiac Arrest	156	(5)
UNIT IV The Circulation
Overview of the Circulation; Medical Physics of Pressure, Flow, and Resistance	161	(10)
Physical Characteristics of the Circulation	161	(2)
Basic Theory of Circulatory Function	163	(1)
Interrelationships Among Pressure, Flow, and Resistance	164	(7)
Blood Flow	164	(2)
Blood Pressure	166	(1)
Resistance to Blood Flow	167	(3)
Effects of Pressure on Vascular Resistance and Tissue Blood Flow	170	(1)
Vascular Distensibility and Functions of the Arterial and Venous Systems	171	(10)
Vascular Distensibility	171	(2)
Vascular Compliance (or Vascular Capacitance)	171	(1)
Volume-Pressure Curves of the Arterial and Venous Circulations	172	(1)
Arterial Pressure Pulsations	173	(3)
Transmission of Pressure Pulses to the Peripheral Arteries	174	(1)
Clinical Methods for Measuring Systolic and Diastolic Pressures	175	(1)
Veins and Their Functions	176	(5)
Venous Pressures---Right Atrial Pressure (Central Venous Pressure) and Peripheral Venous Pressures	176	(3)
Blood Reservoir Function of the Veins	179	(2)
The Microcirculation and the Lymphatic System: Capillary Fluid Exchange, Interstitial Fluid, and Lymph Flow	181	(14)
Structure of the Microcirculation and Capillary System	181	(1)
Flow of Blood in the Capillaries---Vasomotion	182	(1)
Average Function of the Capillary System	183	(1)
Exchange of Water, Nutrients, and Other Substances Between the Blood and Interstitial Fluid	183	(1)
Diffusion Through the Capillary Membrane	183	(1)
The Interstitium and Interstitial Fluid	184	(1)
Fluid Filtration Across Capillaries Is Determined by Hydrostatic and Colloid Osmotic Pressures, and Capillary Filtration Coefficient	185	(5)
Capillary Hydrostatic Pressure	186	(1)
Interstitial Fluid Hydrostatic Pressure	187	(1)
Plasma Colloid Osmotic Pressure	188	(1)
Interstitial Fluid Colloid Osmotic Pressure	188	(1)
Exchange of Fluid Volume Through the Capillary Membrane	189	(1)
Starling Equilibrium for Capillary Exchange	189	(1)
Lymphatic System	190	(5)
Lymph Channels of the Body	190	(1)
Formation of Lymph	191	(1)
Rate of Lymph Flow	192	(1)
Role of the Lymphatic System in Controlling Interstitial Fluid Protein Concentration, Interstitial Fluid Volume, and Interstitial Fluid Pressure	193	(2)
Local and Humoral Control of Blood Flow by the Tissues	195	(9)
Local Control of Blood Flow in Response to Tissue Needs	195	(1)
Mechanisms of Blood Flow Control	196	(5)
Acute Control of Local Blood Flow	196	(4)
Long-Term Blood Flow Regulation	200	(1)
Development of Collateral Circulation---A Phenomenon of Long-Term Local Blood Flow Regulation	201	(1)
Humoral Control of the Circulation	201	(3)
Vasoconstrictor Agents	201	(1)
Vasodilator Agents	202	(1)
Vascular Control by Ions and Other Chemical Factors	202	(2)
Nervous Regulation of the Circulation, and Rapid Control of Arterial Pressure	204	(12)
Nervous Regulation of the Circulation	204	(4)
Autonomic Nervous System	204	(4)
Role of the Nervous System in Rapid Control of Arterial Pressure	208	(5)
Increase in Arterial Pressure During Muscle Exercise and Other Types of Stress	208	(1)
Reflex Mechanisms for Maintaining Normal Arterial Pressure	209	(3)
Central Nervous System Ischemic Response---Control of Arterial Pressure by the Brain's Vasomotor Center in Response to Diminished Brain Blood Flow	212	(1)
Special Features of Nervous Control of Arterial Pressure	213	(3)
Role of the Skeletal Nerves and Skeletal Muscles in Increasing Cardiac Output and Arterial Pressure	213	(1)
Respiratory Waves in the Arterial Pressure	214	(1)
Arterial Pressure ``Vasomotor'' Waves---Oscillation of Pressure Reflex Control Systems	214	(2)
Dominant Role of the Kidney in Long-Term Regulation of Arterial Pressure and in Hypertension: The Integrated System for Pressure Control	216	(16)
Renal-Body Fluid System for Arterial Pressure Control	216	(7)
Quantitation of Pressure Diuresis as a Basis for Arterial Pressure Control	217	(3)
Chronic Hypertension (High Blood Pressure) Is Caused by Impaired Renal Fluid Excretion	220	(3)
The Renin-Angiotensin System: Its Role In Pressure Control and in Hypertension	223	(7)
Components of the Renin-Angiotensin System	223	(3)
Types of Hypertension in Which Angiotensin Is Involved: Hypertension Caused by a Renin-Secreting Tumor or by Infusion of Angiotensin II	226	(1)
Other Types of Hypertension Caused by Combinations of Volume Loading and Vasoconstriction	227	(1)
``Primary (Essential) Hypertension''	228	(2)
Summary of the Integrated, Multifaceted System for Arterial Pressure Regulation	230	(2)
Cardiac Output, Venous Return, and Their Regulation	232	(14)
Normal Values for Cardiac Output at Rest and During Activity	232	(1)
Control of Cardiac Output by Venous Return---Role of the Frank-Starling Mechanism of the Heart	232	(4)
Cardiac Output Regulation Is the Sum of Blood Flow Regulation in All the Local Tissues of the Body---Tissue Metabolism Regulates Most Local Blood Flow	233	(1)
The Heart Has Limits for the Cardiac Output That It Can Achieve	234	(1)
What Is the Role of the Nervous System in Controlling Cardiac Output?	235	(1)
Pathologically High and Pathologically Low Cardiac Outputs	236	(7)
High Cardiac Output Caused by Reduced Total Peripheral Resistance	236	(1)
Low Cardiac Output	237	(1)
A More Quantitative Analysis of Cardiac Output Regulation	237	(1)
Cardiac Output Curves Used in the Quantitative Analysis	237	(1)
Venous Return Curves	238	(3)
Analysis of Cardiac Output and Right Atrial Pressure, Using Simultaneous Cardiac Output and Venous Return Curves	241	(2)
Methods for Measuring Cardiac Output	243	(3)
Pulsatile Output of the Heart as Measured by an Electromagnetic or Ultrasonic Flowmeter	243	(1)
Measurement of Cardiac Output Using the Oxygen Fick Principle	244	(1)
Indicator Dilution Method for Measuring Cardiac Output	244	(2)
Muscle Blood Flow and Cardiac Output During Exercise; the Coronary Circulation and Ischemic Heart Disease	246	(12)
Blood Flow in Skeletal Muscle and Blood Flow Regulation During Exercise	246	(3)
Rate of Blood Flow Through the Muscles	246	(1)
Control of Blood Flow Through the Skeletal Muscles	247	(1)
Total Body Circulatory Readjustments During Exercise	247	(2)
Coronary Circulation	249	(9)
Physiologic Anatomy of the Coronary Blood Supply	249	(1)
Normal Coronary Blood Flow	249	(1)
Control of Coronary Blood Flow	250	(1)
Special Features of Cardiac Muscle Metabolism	251	(1)
Ischemic Heart Disease	252	(1)
Causes of Death After Acute Coronary Occlusion	253	(1)
Stages of Recovery from Acute Myocardial Infarction	254	(1)
Function of the Heart After Recovery from Myocardial Infarction	255	(1)
Pain in Coronary Heart Disease	255	(1)
Surgical Treatment of Coronary Disease	256	(2)
Cardiac Failure	258	(11)
Dynamics of the Circulation in Cardiac Failure	258	(4)
Acute Effects of Moderate Cardiac Failure	258	(1)
Chronic Stage of Failure---Fluid Retention Helps to Compensate Cardiac Output	259	(1)
Summary of the Changes That Occur After Acute Cardiac Failure---``Compensated Heart Failure''	260	(1)
Dynamics of Severe Cardiac Failure---Decompensated Heart Failure	260	(2)
Unilateral Left Heart Failure	262	(1)
Low-Output Cardiac Failure---Cardiogenic Shock	262	(1)
Edema in Patients with Cardiac Failure	263	(1)
Cardiac Reserve	264	(5)
Quantitative Graphical Method for Analysis of Cardiac Failure	265	(4)
Heart Valves and Heart Sounds; Dynamics of Valvular and Congenital Heart Defects	269	(9)
Heart Sounds	269	(3)
Normal Heart Sounds	269	(2)
Valvular Lesions	271	(1)
Abnormal Circulatory Dynamics in Valvular Heart Disease	272	(2)
Dynamics of the Circulation in Aortic Stenosis and Aortic Regurgitation	272	(1)
Dynamics of Mitral Stenosis and Mitral Regurgitation	273	(1)
Circulatory Dynamics During Exercise in Patients with Valvular Lesions	273	(1)
Abnormal Circulatory Dynamics in Congenital Heart Defects	274	(2)
Patent Ductus Arteriosus---A Left-to-Right Shunt	274	(1)
Tetralogy of Fallot---A Right-to-Left Shunt	274	(2)
Causes of Congenital Anomalies	276	(1)
Use of Extracorporeal Circulation During Cardiac Surgery	276	(1)
Hypertrophy of the Heart in Valvular and Congenital Heart Disease	276	(2)
Circulatory Shock and Physiology of Its Treatment	278	(13)
Physiologic Causes of Shock	278	(1)
Circulatory Shock Caused by Decreased Cardiac Output	278	(1)
Circulatory Shock That Occurs Without Diminished Cardiac Output	278	(1)
What Happens to the Arterial Pressure in Circulatory Shock?	279	(1)
Tissue Deterioration Is the End Result of Circulatory Shock, Whatever the Cause	279	(1)
Stages of Shock	279	(1)
Shock Caused by Hypovolemia---Hemorrhagic Shock	279	(6)
Relationship of Bleeding Volume to Cardiac Output and Arterial Pressure	279	(1)
Progressive and Nonprogressive Hemorrhagic Shock	280	(4)
Irreversible Shock	284	(1)
Hypovolemic Shock Caused by Plasma Loss	284	(1)
Hypovolemic Shock Caused by Trauma	285	(1)
Neurogenic Shock---Increased Vascular Capacity	285	(1)
Anaphylactic Shock and Histamine Shock	285	(1)
Septic Shock	286	(1)
Physiology of Treatment in Shock	286	(1)
Replacement Therapy	286	(1)
Treatment of Shock with Sympathomimetic Drugs---Sometimes Useful, Sometimes Not	287	(1)
Other Therapy	287	(1)
Circulatory Arrest	287	(4)
Effect of Circulatory Arrest on the Brain	287	(4)
UNIT V The Body Fluids and Kidneys
The Body Fluid Compartments: Extracellular and Intracellular Fluids; Interstitial Fluid and Edema	291	(16)
Fluid Intake and Output Are Balanced During Steady-State Conditions	291	(1)
Daily Intake of Water	291	(1)
Daily Loss of Body Water	291	(1)
Body Fluid Compartments	292	(1)
Intracellular Fluid Compartment	293	(1)
Extracellular Fluid Compartment	293	(1)
Blood Volume	293	(1)
Constituents of Extracellular and Intracellular Fluids	293	(2)
Ionic Composition of Plasma and Interstitial Fluid Is Similar	293	(2)
Important Constituents of the Intracellular Fluid	295	(1)
Measurement of Fluid Volumes in the Different Body Fluid Compartments---The Indicator-Dilution Principle	295	(1)
Determination of Volumes of Specific Body Fluid Compartments	295	(1)
Regulation of Fluid Exchange and Osmotic Equilibrium Between Intracellular and Extracellular Fluid	296	(1)
Basic Principles of Osmosis and Osmotic Pressure	296	(2)
Osmotic Equilibrium Is Maintained Between Intracellular and Extracellular Fluids	298	(1)
Volume and Osmolality of Extracellular and Intracellular Fluids in Abnormal States	299	(2)
Effect of Adding Saline Solution to the Extracellular Fluid	299	(2)
Glucose and Other Solutions Administered for Nutritive Purposes	301	(1)
Clinical Abnormalities of Fluid Volume Regulation: Hyponatremia and Hypernatremia	301	(1)
Causes of Hyponatremia: Excess Water or Loss of Sodium	301	(1)
Causes of Hypernatremia: Water Loss or Excess Sodium	302	(1)
Edema: Excess Fluid in the Tissues	302	(3)
Intracellular Edema	302	(1)
Extracellular Edema	302	(1)
Summary of Causes of Extracellular Edema	303	(1)
Safety Factors That Normally Prevent Edema	304	(1)
Fluids in the ``Potential Spaces'' of the Body	305	(2)
Urine Formation by the Kidneys: I. Glomerular Filtration, Renal Blood Flow, and Their Control	307	(20)
Multiple Functions of the Kidneys in Homeostasis	307	(1)
Physiologic Anatomy of the Kidneys	308	(3)
General Organization of the Kidneys and Urinary Tract	308	(1)
Renal Blood Supply	309	(1)
The Nephron Is the Functional Unit of the Kidney	310	(1)
Micturition	311	(1)
Physiologic Anatomy and Nervous Connections of the Bladder	311	(1)
Transport of Urine from the Kidney Through the Ureters and into the Bladder	312	(1)
Innervation of the Bladder	312	(1)
Filling of the Bladder and Bladder Wall Tone; the Cystometrogram	312	(1)
Micturition Reflex	313	(1)
Facilitation or Inhibition of Micturition by the Brain	313	(1)
Abnormalities of Micturition	313	(1)
Urine Formation Results from Glomerular Filtration, Tubular Reabsorption, and Tubular Secretion	314	(2)
Filtration, Reabsorption, and Secretion of Different Substances	315	(1)
Glomerular Filtration---The First Step in Urine Formation	316	(1)
Composition of the Glomerular Filtrate	316	(1)
GFR Is About 20 Per Cent of the Renal Plasma Flow	316	(1)
Glomerular Capillary Membrane	316	(1)
Determinants of the GFR	317	(3)
Increased Glomerular Capillary Filtration Coefficient Increases GFR	318	(1)
Increased Bowman's Capsule Hydrostatic Pressure Decreases GFR	318	(1)
Increased Glomerular Capillary Colloid Osmotic Pressure Decreases GFR	318	(1)
Increased Glomerular Capillary Hydrostatic Pressure Increases GFR	319	(1)
Renal Blood Flow	320	(1)
Renal Blood Flow and Oxygen Consumption	320	(1)
Determinants of Renal Blood Flow	320	(1)
Blood Flow in the Vasa Recta of the Renal Medulla Is Very Low Compared with Flow in the Renal Cortex	321	(1)
Physiologic Control of Glomerular Filtration and Renal Blood Flow	321	(2)
Sympathetic Nervous System Activation Decreases GFR	321	(1)
Hormonal and Autacoid Control of Renal Circulation	322	(1)
Autoregulation of GFR and Renal Blood Flow	323	(4)
Importance of GFR Autoregulation in Preventing Extreme Changes in Renal Excretion	323	(1)
Role of Tubuloglomerular Feedback in Autoregulation of GFR	323	(2)
Myogenic Autoregulation of Renal Blood Flow and GFR	325	(1)
Other Factors That Increase Renal Blood Flow and GFR: High Protein Intake and Increased Blood Glucose	325	(2)
Urine Formation by the Kidneys: II. Tubular Processing of the Glomerular Filtrate	327	(21)
Reabsorption and Secretion by the Renal Tubules	327	(1)
Tubular Reabsorption Is Selective and Quantitatively Large	327	(1)
Tubular Reabsorption Includes Passive and Active Mechanisms	328	(5)
Active Transport	328	(4)
Passive Water Reabsorption by Osmosis Is Coupled Mainly to Sodium Reabsorption	332	(1)
Reabsorption of Chloride, Urea, and Other Solutes by Passive Diffusion	332	(1)
Reabsorption and Secretion Along Different Parts of the Nephron	333	(6)
Proximal Tubular Reabsorption	333	(1)
Solute and Water Transport in the Loop of Henle	334	(2)
Distal Tubule	336	(1)
Late Distal Tubule and Cortical Collecting Tubule	336	(1)
Medullary Collecting Duct	337	(1)
Summary of Concentrations of Different Solutes in the Different Tubular Segments	338	(1)
Regulation of Tubular Reabsorption	339	(4)
Glomerulotubular Balance---The Ability of the Tubules to Increase Reabsorption Rate in Response to Increased Tubular Load	339	(1)
Peritubular Capillary and Renal Interstitial Fluid Physical Forces	339	(2)
Effect of Arterial Pressure on Urine Output---The Pressure-Natriuresis and Pressure-Diuresis Mechanisms	341	(1)
Hormonal Control of Tubular Reabsorption	342	(1)
Sympathetic Nervous System Activation Increases Sodium Reabsorption	343	(1)
Use of Clearance Methods to Quantify Kidney Function	343	(5)
Inulin Clearance Can Be Used to Estimate GFR	344	(1)
Creatine Clearance and Plasma Creatinine Clearance Can Be Used to Estimate GFR	344	(1)
PAH Clearance Can Be Used to Estimate Renal Plasma Flow	345	(1)
Filtration Fraction Is Calculated from GFR Divided by Renal Plasma Flow	346	(1)
Calculation of Tubular Reabsorption or Secretion from Renal Clearance	346	(2)
Regulation of Extracellular Fluid Osmolarity and Sodium Concentration	348	(17)
The Kidneys Excrete Excess Water by Forming a Dilute Urine	348	(2)
Antidiuretic Hormone Controls Urine Concentration	348	(1)
Renal Mechanisms for Excreting a Dilute Urine	349	(1)
The Kidneys Conserve Water by Excreting a Concentrated Urine	350	(7)
Obligatory Urine Volume	350	(1)
Requirements for Excreting a Concentrated Urine---High ADH Levels and Hyperosmotic Renal Medulla	350	(1)
Countercurrent Mechanism Produces a Hyperosmotic Renal Medullary Interstitium	351	(1)
Role of Distal Tubule and Collecting Ducts in Excreting a Concentrated Urine	352	(1)
Urea Contributes to Hyperosmotic Renal Medullary Interstitium and to a Concentrated Urine	353	(1)
Countercurrent Exchange in the Vasa Recta Preserves Hyperosmolarity of the Renal Medulla	354	(1)
Summary of Urine Concentrating Mechanism and Changes in Osmolarity in Different Segments of the Tubules	355	(2)
Quantifying Renal Urine Concentration and Dilution: ``Free Water'' and Osmolar Clearances	357	(1)
Disorders of Urinary Concentrating Ability	357	(1)
Control of Extracellular Fluid Osmolarity and Sodium Concentration	358	(1)
Estimating Plasma Osmolarity from Plasma Sodium Concentration	358	(1)
Osmoreceptor-ADH Feedback System	358	(3)
ADH Synthesis in Supraoptic and Paraventricular Nuclei of the Hypothalamus and ADH Release from the Posterior Pituitary	359	(1)
Cardiovascular Reflex Stimulation of ADH Release by Decreased Arterial Pressure and/or Decreased Blood Volume	360	(1)
Quantitative Importance of Cardiovascular Reflexes and Osmolarity in Stimulating ADH Secretion	360	(1)
Other Stimuli for ADH Secretion	360	(1)
Role of Thirst in Controlling Extracellular Fluid Osmolarity and Sodium Concentration	361	(2)
Central Nervous System Centers for Thirst	361	(1)
Stimuli for Thirst	361	(1)
Threshold for Osmolar Stimulus of Drinking	362	(1)
Integrated Responses of Osmoreceptor-ADH and Thirst Mechanisms in Controlling Extracellular Fluid Osmolarity and Sodium Concentration	362	(1)
Role of Angiotensin II and Aldosterone in Controlling Extracellular Fluid Osmolarity and Sodium Concentration	362	(1)
Salt-Appetite Mechanism for Controlling Extracellular Fluid Sodium Concentration and Volume	363	(2)
Renal Regulation of Potassium, Calcium, Phosphate, and Magnesium; Integration of Renal Mechanisms for Control of Blood Volume and Extracellular Fluid Volume	365	(18)
Regulation of Potassium Excretion and Potassium Concentration in Extracellular Fluid	365	(6)
Regulation of Internal Potassium Distribution	366	(1)
Overview of Renal Potassium Excretion	367	(1)
Potassium Secretion by Principal Cells of Late Distal and Cortical Collecting Tubules	367	(1)
Summary of Factors That Regulate Potassium Secretion: Plasma Potassium Concentration, Aldosterone, Tubular Flow Rate, and Hydrogen Ion Concentration	368	(3)
Control of Renal Calcium Excretion and Extracellular Calcium Ion Concentration	371	(2)
Control of Calcium Excretion by the Kidneys	372	(1)
Regulation of Renal Phosphate Excretion	372	(1)
Control of Renal Magnesium Excretion and Extracellular Magnesium Ion Concentration	373	(1)
Integration of Renal Mechanisms for Control of Extracellular Fluid	373	(1)
Sodium Excretion Is Precisely Matched to Intake Under Steady-State Conditions	373	(1)
Sodium Excretion Is Controlled by Altering Glomerular Filtration or Tubular Sodium Reabsorption Rates	374	(1)
Importance of Pressure Natriuresis and Pressure Diuresis in Maintaining Body Sodium and Fluid Balance	374	(2)
Pressure Natriuresis and Diuresis Are Key Components of a Renal-Body Fluid Feedback for Regulating Body Fluid Volumes and Arterial Pressure	375	(1)
Precision of Blood Volume and Extracellular Fluid Volume Regulation	376	(1)
Distribution of Extracellular Fluid Between the Interstitial Spaces and Vascular System	376	(1)
Nervous and Hormonal Factors Increase the Effectiveness of Renal-Body Fluid Feedback Control	377	(3)
Sympathetic Nervous System Control of Renal Excretion: Arterial Baroreceptor and Low-Pressure Stretch Receptor Reflexes	377	(1)
Role of Angiotensin II in Controlling Renal Excretion	377	(1)
Role of Aldosterone in Controlling Renal Excretion	378	(1)
Role of ADH in Controlling Renal Water Excretion	379
Role of Atrial Natriuretic Peptide in Controlling Renal Excretion	378	(2)
Integrated Responses to Changes in Sodium Intake	380	(1)
Conditions That Cause Large Increases in Blood Volume and Extracellular Fluid Volume	380	(1)
Increased Blood Volume and Extracellular Fluid Volume Caused by Heart Diseases	380	(1)
Increased Blood Volume Caused by Increased Capacity of Circulation	380	(1)
Conditions That Cause Large Increases in Extracellular Fluid Volume but with Normal Blood Volume	381	(2)
Nephrotic Syndrome---Loss of Plasma Proteins in Urine and Sodium Retention by the Kidneys	381	(1)
Liver Cirrhosis---Decreased Synthesis of Plasma Proteins by the Liver and Sodium Retention by the Kidneys	381	(2)
Regulation of Acid-Base Balance	383	(19)
Hydrogen Ion Concentration Is Precisely Regulated	383	(1)
Acids and Bases---Their Definitions and Meanings	383	(1)
Defenses Against Changes in Hydrogen Ion Concentration: Buffers, Lungs, and Kidneys	384	(1)
Buffering of Hydrogen Ions in the Body Fluids	385	(1)
Bicarbonate Buffer System	385	(2)
Quantitative Dynamics of the Bicarbonate Buffer System	385	(2)
Phosphate Buffer System	387	(1)
Proteins: Important Intracellular Buffers	387	(1)
Respiratory Regulation of Acid-Base Balance	388	(2)
Pulmonary Expiration of CO2 Balances Metabolic Formation of CO2	388	(1)
Increasing Alveolar Ventilation Decreases Extracellular Fluid Hydrogen Ion Concentration and Raises pH	388	(1)
Increased Hydrogen Ion Concentration Stimulates Alveolar Ventilation	389	(1)
Renal Control of Acid-Base Balance	390	(1)
Secretion of Hydrogen Ions and Reabsorption of Bicarbonate Ions by the Renal Tubules	390	(2)
Hydrogen Ions Are Secreted by Secondary Active Transport in the Early Tubular Segments	391	(1)
Filtered Bicarbonate Ions Are Reabsorbed by Interaction with Hydrogen Ions in the Tubules	391	(1)
Primary Active Secretion of Hydrogen Ions in the Intercalated Cells of Late Distal and Collecting Tubules	392	(1)
Combination of Excess Hydrogen Ions with Phosphate and Ammonia Buffers in the Tubule---A Mechanism for Generating ``New'' Bicarbonate Ions	392	(2)
Phosphate Buffer System Carries Excess Hydrogen Ions into the Urine and Generates New Bicarbonate	393	(1)
Excretion of Excess Hydrogen Ions and Generation of New Bicarbonate by the Ammonia Buffer System	393	(1)
Quantifying Renal Acid-Base Excretion	394	(2)
Regulation of Renal Tubular Hydrogen Ion Secretion	395	(1)
Renal Correction of Acidosis---Increased Excretion of Hydrogen Ions and Addition of Bicarbonate Ions to the Extracellular Fluid	396	(1)
Acidosis Decreases the Ratio of HCO3-/H+ in Renal Tubular Fluid	396	(1)
Renal Correction of Alkalosis---Decreased Tubular Secretion of Hydrogen Ions and Increased Excretion of Bicarbonate Ions	396	(1)
Alkalosis Increases the Ratio of HCO3-/H+ in Renal Tubular Fluid	396	(1)
Clinical Causes of Acid-Base Disorders	397	(1)
Respiratory Acidosis Is Caused by Decreased Ventilation and Increased PCO2	397	(1)
Respiratory Alkalosis Results from Increased Ventilation and Decreased PCO2	397	(1)
Metabolic Acidosis Results from Decreased Extracellular Fluid Bicarbonate Concentration	397	(1)
Treatment of Acidosis or Alkalosis	398	(1)
Clinical Measurements and Analysis of Acid-Base Disorders	398	(4)
Complex Acid-Base Disorders and Use of the Acid-Base Nomogram for Diagnosis	399	(1)
Use of Anion Gap to Diagnose Acid-Base Disorders	400	(2)
Kidney Diseases and Diuretics	402	(17)
Diuretics and Their Mechanisms of Action	402	(2)
Osmotic Diuretics Decrease Water Reabsorption by Increasing Osmotic Pressure of Tubular Fluid	402	(1)
``Loop'' Diuretics Decrease Active Sodium-Chloride-Potassium Reabsorption in the Thick Ascending Loop of Henle	403	(1)
Thiazide Diuretics Inhibit Sodium-Chloride Reabsorption in the Early Distal Tubule	404	(1)
Carbonic Anhydrase Inhibitors Block Sodium-Bicarbonate Reabsorption in the Proximal Tubules	404	(1)
Competitive Inhibitors of Aldosterone Decrease Sodium Reabsorption from and Potassium Secretion into the Cortical Collecting Tubule	404	(1)
Diuretics That Block Sodium Channels in the Collecting Tubules Decrease Sodium Reabsorption	404	(1)
Kidney Diseases	404	(1)
Acute Renal Failure	404	(2)
Prerenal Acute Renal Failure Caused by Decreased Blood Flow to the Kidney	405	(1)
Intrarenal Acute Renal Failure Caused by Abnormalities within the Kidney	405	(1)
Postrenal Acute Renal Failure Caused by Abnormalities of the Lower Urinary Tract	406	(1)
Physiologic Effects of Acute Renal Failure	406	(1)
Chronic Renal Failure: An Irreversible Decrease in the Number of Functional Nephrons	406	(7)
Vicious Circle of Chronic Renal Failure Leading to End-Stage Renal Disease	407	(1)
Injury to the Renal Vasculature as a Cause of Chronic Renal Failure	408	(1)
Injury to the Glomeruli as a Cause of Chronic Renal Failure---Glomerulonephritis	408	(1)
Injury to the Renal Interstitium as a Cause of Chronic Renal Failure---Pyelonephritis	409	(1)
Nephrotic Syndrome---Excretion of Protein in the Urine Because of Increased Glomerular Permeability	409	(1)
Nephron Function in Chronic Renal Failure	409	(2)
Effects of Renal Failure on the Body Fluids---Uremia	411	(1)
Hypertension and Kidney Disease	412	(1)
Specific Tubular Disorders	413	(1)
Treatment of Renal Failure by Dialysis with an Artificial Kidney	414	(5)
UNIT VI Blood Cells, Immunity, and Blood Clotting
Red Blood Cells, Anemia, and Polycythemia	419	(10)
Red Blood Cells (Erythrocytes)	419	(7)
Production of Red Blood Cells	420	(4)
Formation of Hemoglobin	424	(1)
Iron Metabolism	425	(1)
Life Span and Destruction of Red Blood Cells	426	(1)
Anemias	426	(1)
Effects of Anemia on Function of the Circulatory System	427	(1)
Polycythemia	427	(2)
Effect of Polycythemia on Function of the Circulatory System	428	(1)
Resistance of the Body to Infection: I. Leukocytes, Granulocytes, the Monocyte-Macrophage System, and Inflammation	429	(10)
Leukocytes (White Blood Cells)	429	(2)
General Characteristics of Leukocytes	429	(1)
Genesis of the White Blood Cells	430	(1)
Life Span of the White Blood Cells	431	(1)
Neutrophils and Macrophages Defend Against Infections	431	(1)
Phagocytosis	431	(1)
Monocyte-Macrophage Cell System (Reticuloendothelial System)	432	(2)
Inflammation: Role of Neutrophils and Macrophages	434	(2)
Inflammation	434	(1)
Macrophage and Neutrophil Responses During Inflammation	434	(2)
Eosinophils	436	(1)
Basophils	436	(1)
Leukopenia	436	(1)
The Leukemias	437	(2)
Effects of Leukemia on the Body	437	(2)
Resistance of the Body to Infection: II. Immunity and Allergy	439	(12)
Innate Immunity	439	(1)
Acquired (Adaptive) Immunity	439	(10)
Basic Types of Acquired Immunity	440	(1)
Both Types of Acquired Immunity Are Initiated by Antigens	440	(1)
Lymphocytes Are Responsible for Acquired Immunity	440	(1)
Preprocessing of the T and B Lymphocytes	440	(2)
T Lymphocytes and B-Lymphocyte Antibodies React Highly Specifically Against Specific Antigens---Role of Lymphocyte Clones	442	(1)
Origin of the Many Clones of Lymphocytes	442	(1)
Specific Attributes of the B-Lymphocyte System---Humoral Immunity and the Antibodies	443	(3)
Special Attributes of the T-Lymphocyte System---Activated T Cells and Cell-Mediated Immunity	446	(1)
Several Types of T Cells and Their Different Functions	446	(2)
Tolerance of the Acquired Immunity System to One's Own Tissues---Role of Preprocessing in the Thymus and Bone Marrow	448	(1)
Immunization by Injection of Antigens	448	(1)
Passive Immunity	449	(1)
Allergy and Hypersensitivity	449	(2)
Allergy Caused by Activated T Cells: Delayed-Reaction Allergy	449	(1)
Allergies in the ``Allergic'' Person, Who Has Excess IgE Antibodies	449	(2)
Blood Types; Transfusion; Tissue and Organ Transplantation	451	(6)
Antigenicity Causes Immune Reactions of Blood	451	(1)
O-A-B Blood Types	451	(2)
A and B Antigens---Agglutinogens	451	(1)
Agglutinins	452	(1)
Agglutination Process In Transfusion Reactions	452	(1)
Blood Typing	453	(1)
Rh Blood Types	453	(2)
Rh Immune Response	453	(1)
Transfusion Reactions Resulting from Mismatched Blood Types	454	(1)
Transplantation of Tissues and Organs	455	(2)
Attempts to Overcome Immune Reactions in Transplanted Tissue	455	(2)
Hemostasis and Blood Coagulation	457	(14)
Events in Hemostasis	457	(2)
Vascular Constriction	457	(1)
Formation of the Platelet Plug	457	(1)
Blood Coagulation in the Ruptured Vessel	458	(1)
Fibrous Organization or Dissolution of the Blood Clot	458	(1)
Mechanism of Blood Coagulation	459	(5)
Conversion of Prothrombin to Thrombin	459	(1)
Conversion of Fibrinogen to Fibrin---Formation of the Clot	460	(1)
Vicious Circle of Clot Formation	460	(1)
Initiation of Coagulation: Formation of Prothrombin Activator	461	(2)
Prevention of Blood Clotting in the Normal Vascular System---Intravascular Anticoagulants	463	(1)
Lysis of Blood Clots---Plasmin	464	(1)
Conditions That Cause Excessive Bleeding in Human Beings	464	(1)
Decreased Prothrombin, Factor VII, Factor IX, and Factor X Caused by Vitamin K Deficiency	464	(1)
Hemophilia	465	(1)
Thrombocytopenia	465	(1)
Thromboembolic Conditions in the Human Being	465	(1)
Femoral Venous Thrombosis and Massive Pulmonary Embolism	466	(1)
Disseminated Intravascular Coagulation	466	(1)
Anticoagulants for Clinical Use	466	(1)
Heparin as an Intravenous Anticoagulant	466	(1)
Coumarins as Anticoagulants	466	(1)
Prevention of Blood Coagulation Outside the Body	466	(1)
Blood Coagulation Tests	467	(4)
Bleeding Time	467	(1)
Clotting Time	467	(1)
Prothrombin Time	467	(4)
UNIT VII Respiration
Pulmonary Ventilation	471	(12)
Mechanics of Pulmonary Ventilation	471	(4)
Muscles That Cause Lung Expansion and Contraction	471	(1)
Movement of Air In and Out of the Lungs and the Pressures That Cause the Movement	472	(2)
Effect of the Thoracic Cage on Lung Expansibility	474	(1)
Pulmonary Volumes and Capacities	475	(2)
Recording Changes in Pulmonary Volume---Spirometry	475	(1)
Abbreviations and Symbols Used in Pulmonary Function Tests	476	(1)
Determination of Functional Residual Capacity, Residual Volume, and Total Lung Capacity---Helium Dilution Method	476	(1)
Minute Respiratory Volume Equals Respiratory Rate Times Tidal Volume	477	(1)
Alveolar Ventilation	477	(1)
``Dead Space'' and Its Effect on Alveolar Ventilation	477	(1)
Rate of Alveolar Ventilation	478	(1)
Functions of the Respiratory Passageways	478	(5)
Trachea, Bronchi, and Bronchioles	478	(2)
Normal Respiratory Functions of the Nose	480	(3)
Pulmonary Circulation, Pulmonary Edema, Pleural Fluid	483	(8)
Physiologic Anatomy of the Pulmonary Circulatory System	483	(1)
Pressures in the Pulmonary System	483	(1)
Blood Volume of the Lungs	484	(1)
Blood Flow Through the Lungs and Its Distribution	485	(1)
Effect of Hydrostatic Pressure Gradients in the Lungs on Regional Pulmonary Blood Flow	485	(2)
Zones 1, 2, and 3 of Pulmonary Blood Flow	485	(1)
Effect of Increased Cardiac Output on Pulmonary Blood Flow and Pulmonary Arterial Pressure During Heavy Exercise	486	(1)
Function of the Pulmonary Circulation When the Left Atrial Pressure Rises as a Result of Left-Sided Heart Failure	487	(1)
Pulmonary Capillary Dynamics	487	(2)
Capillary Exchange of Fluid in the Lungs, and Pulmonary Interstitial Fluid Dynamics	487	(1)
Pulmonary Edema	488	(1)
Fluid in the Pleural Cavity	489	(2)
Physical Principles of Gas Exchange; Diffusion of Oxygen and Carbon Dioxide Through the Respiratory Membrane	491	(11)
Physics of Gas Diffusion and Gas Partial Pressures	491	(2)
Molecular Basis of Gas Diffusion	491	(1)
Gas Pressures in a Mixture of Gases---``Partial Pressures'' of Individual Gases	491	(1)
Pressures of Gases Dissolved in Water and Tissues	492	(1)
Vapor Pressure of Water	492	(1)
Diffusion of Gases Through Fluids---Pressure Difference Causes Net Diffusion	493	(1)
Diffusion of Gases Through Tissues	493	(1)
Composition of Alveolar Air---Its Relation to Atmospheric Air	493	(3)
Rate at Which Alveolar Air Is Renewed by Atmospheric Air	494	(1)
Oxygen Concentration and Partial Pressure in the Alveoli	494	(1)
CO2 Concentration and Partial Pressure in the Alveoli	495	(1)
Expired Air	495	(1)
Diffusion of Gases Through the Respiratory Membrane	496	(3)
Factors That Affect the Rate of Gas Diffusion Through the Respiratory Membrane	498	(1)
Diffusing Capacity of the Respiratory Membrane	498	(1)
Effect of the Ventilation-Perfusion Ratio on Alveolar Gas Concentration	499	(3)
PO2-PCO2, VA/Q Diagram	500	(1)
Concept of the ``Physiological Shunt'' (When VA/Q Is Greater Than Normal)	500	(1)
Abnormalities of Ventilation-Perfusion Ratio	501	(1)
Transport of Oxygen and Carbon Dioxide in Blood and Tissue Fluids	502	(12)
Transport of Oxygen from the Lungs to the Body Tissues	502	(8)
Diffusion of Oxygen from the Alveoli to the Pulmonary Capillary Blood	502	(1)
Transport of Oxygen in the Arterial Blood	503	(1)
Diffusion of Oxygen from the Peripheral Capillaries into the Tissue Fluid	503	(1)
Diffusion of Oxygen from the Peripheral Capillaries to the Tissue Cells	504	(1)
Diffusion of Carbon Dioxide from the Peripheral Tissue Cells into the Capillaries and from the Pulmonary Capillaries into the Alveoli	504	(1)
Role of Hemoglobin in Oxygen Transport	505	(1)
Reversible Combination of Oxygen with Hemoglobin	505	(2)
Effect of Hemoglobin to ``Buffer'' the Tissue PO2	507	(1)
Factors That Shift the Oxygen-Hemoglobin Dissociation Curve---Their Importance for Oxygen Transport	507	(1)
Metabolic Use of Oxygen by the Cells	508	(1)
Transport of Oxygen in the Dissolved State	509	(1)
Combination of Hemoglobin with Carbon Monoxide---Displacement of Oxygen	509	(1)
Transport of Carbon Dioxide in the Blood	510	(2)
Chemical Forms In Which Carbon Dioxide Is Transported	510	(1)
Carbon Dioxide Dissociation Curve	511	(1)
When Oxygen Binds with Hemoglobin, Carbon Dioxide Is Released (the Haldane Effect) to Increase CO2 Transport	511	(1)
Change in Blood Acidity During Carbon Dioxide Transport	512	(1)
Respiratory Exchange Ratio	512	(2)
Regulation of Respiration	514	(10)
Respiratory Center	514	(2)
Dorsal Respiratory Group of Neurons---Its Control of Inspiration and of Respiratory Rhythm	514	(1)
A Pneumotaxic Center Limits the Duration of Inspiration and Increases the Respiratory Rate	514	(1)
Ventral Respiratory Group of Neurons---Functions in Both Inspiration and Expiration	515	(1)
Lung Inflation Signals Limit Inspiration---The Hering-Breuer Inflation Reflex	515	(1)
Control of Overall Respiratory Center Activity	516	(1)
Chemical Control of Respiration	516	(2)
Direct Chemical Control of Respiratory Center Activity by Carbon Dioxide and Hydrogen Ions	516	(2)
Peripheral Chemoreceptor System for Control of Respiratory Activity---Role of Oxygen in Respiratory Control	518	(2)
Effect of Low Arterial PO2 to Stimulate Alveolar Ventilation When Arterial Carbon Dioxide and Hydrogen Ion Concentrations Remain Normal	519	(1)
Chronic Breathing of Low Oxygen Stimulates Respiration Even More---The Phenomenon of ``Acclimatization''	519	(1)
Composite Effects of PCO2, pH, and PO2 on Alveolar Ventilation	519	(1)
Regulation of Respiration During Exercise	520	(1)
Other Factors That Affect Respiration	521	(3)
Sleep Apnea	522	(2)
Respiratory Insufficiency---Pathophysiology, Diagnosis, Oxygen Therapy	524	(13)
Useful Methods for Studying Respiratory Abnormalities	524	(1)
Study of Blood Gases and Blood pH	524	(1)
Measurement of Maximum Expiratory Flow	525	(1)
Forced Expiratory Vital Capacity and Forced Expiratory Volume	526	(1)
Physiologic Peculiarities of Specific Pulmonary Abnormalities	526	(4)
Chronic Pulmonary Emphysema	526	(1)
Pneumonia	527	(1)
Atelectasis	528	(1)
Asthma	529	(1)
Tuberculosis	530	(1)
Hypoxia and Oxygen Therapy	530	(1)
Oxygen Therapy in Different Types of Hypoxia	530	(1)
Cyanosis	531	(1)
Hypercapnia	531	(1)
Dyspnea	532	(1)
Artificial Respiration	532	(5)
UNIT VIII Aviation, Space, and Deep-Sea Diving Physiology
Aviation, High-Altitude, and Space Physiology	537	(8)
Effects of Low Oxygen Pressure on the Body	537	(4)
Alveolar PO2 at Different Elevations	537	(1)
Effect of Breathing Pure Oxygen on Alveolar PO2 at Different Altitudes	538	(1)
Acute Effects of Hypoxia	538	(1)
Acclimatization to Low PO2	539	(1)
Natural Acclimatization of Native Human Beings Living at High Altitudes	540	(1)
Reduced Work Capacity at High Altitudes and Positive Effect of Acclimatization	540	(1)
Acute Mountain Sickness and High-Altitude Pulmonary Edema	540	(1)
Chronic Mountain Sickness	541	(1)
Effects of Acceleratory Forces on the Body in Aviation and Space Physiology	541	(2)
Centrifugal Acceleratory Forces	541	(1)
Effects of Linear Acceleratory Forces on the Body	542	(1)
``Artificial Climate'' in the Sealed Spacecraft	543	(1)
Weightlessness in Space	543	(2)
Physiology of Deep-Sea Diving and Other Hyperbaric Conditions	545	(10)
Effect of High Partial Pressures of Individual Gases on the Body	545	(4)
Nitrogen Narcosis at High Nitrogen Pressures	545	(1)
Oxygen Toxicity at High Pressures	546	(1)
Carbon Dioxide Toxicity at Great Depths in the Sea	547	(1)
Decompression of the Diver After Excess Exposure to High Pressure	547	(2)
Scuba (Self-Contained Underwater Breathing Apparatus) Diving	549	(1)
Special Physiologic Problems in Submarines	550	(1)
Hyperbaric Oxygen Therapy	550	(5)
UNIT IX The Nervous System: A. General Principles and Sensory Physiology
Organization of the Nervous System, Basic Functions of Synapses, ``Transmitter Substances''	555	(17)
General Design of the Nervous System	555	(2)
Central Nervous System Neuron: The Basic Functional Unit	555	(1)
Sensory Part of the Nervous System---Sensory Receptors	555	(1)
Motor Part of the Nervous System---Effectors	556	(1)
Processing of Information---``Integrative'' Function of the Nervous System	556	(1)
Storage of Information---Memory	557	(1)
Major Levels of Central Nervous System Function	557	(1)
Spinal Cord Level	557	(1)
Lower Brain or Subcortical Level	558	(1)
Higher Brain or Cortical Level	558	(1)
Comparison of the Nervous System with a Computer	558	(1)
Central Nervous System Synapses	559	(11)
Types of Synapses---Chemical and Electrical	559	(1)
Physiologic Anatomy of the Synapse	559	(3)
Chemical Substances That Function as Synaptic Transmitters	562	(2)
Electrical Events During Neuronal Excitation	564	(2)
Electrical Events During Neuronal Inhibition	566	(2)
Special Functions of Dendrites for Exciting Neurons	568	(1)
Relation of State of Excitation of the Neuron to Rate of Firing	569	(1)
Some Special Characteristics of Synaptic Transmission	570	(2)
Sensory Receptors, Neuronal Circuits for Processing Information	572	(13)
Types of Sensory Receptors and the Sensory Stimuli They Detect	572	(1)
Differential Sensitivity of Receptors	572	(1)
Transduction of Sensory Stimuli into Nerve Impulses	573	(3)
Local Electrical Currents at Nerve Endings---Receptor Potentials	573	(2)
Adaptation of Receptors	575	(1)
Nerve Fibers That Transmit Different Types of Signals, and Their Physiologic Classification	576	(1)
Transmission of Signals of Different Intensity in Nerve Tracts---Spatial and Temporal Summation	577	(1)
Transmission and Processing of Signals in Neuronal Pools	578	(5)
Relaying of Signals Through Neuronal Pools	579	(2)
Prolongation of a Signal by a Neuronal Pool---``Afterdischarge''	581	(2)
Instability and Stability of Neuronal Circuits	583	(2)
Inhibitory Circuits as a Mechanism for Stabilizing Nervous System Function	583	(1)
Synaptic Fatigue as a Means for Stabilizing the Nervous System	583	(2)
Somatic Sensations: I. General Organization, the Tactile and Position Senses	585	(13)
Classification of Somatic Senses	585	(1)
Detection and Transmission of Tactile Sensations	585	(2)
Detection of Vibration	587	(1)
Tickle and Itch	587	(1)
Sensory Pathways for Transmitting Somatic Signals into the Central Nervous System	587	(1)
Dorsal Column--Medial Lemniscal System	588	(1)
Anterolateral System	588	(1)
Transmission in the Dorsal Column---Medial Lemniscal System	588	(7)
Anatomy of the Dorsal Column---Medial Lemniscal System	588	(1)
Somatosensory Cortex	589	(3)
Somatosensory Association Areas	592	(1)
Overall Characteristics of Signal Transmission and Analysis in the Dorsal Column--Medial Lemniscal System	592	(2)
Position Senses	594
Interpretation of Sensory Stimulus Intensity	593	(1)
Judgment of Stimulus Intensity	594	(1)
Position Senses	594	(1)
Transmission of Less Critical Sensory Signals in the Anterolateral Pathway	595	(1)
Anatomy of the Anterolateral Pathway	595	(1)
Some Special Aspects of Somatosensory Function	596	(2)
Function of the Thalamus in Somatic Sensation	596	(1)
Cortical Control of Sensory Sensitivity---``Corticofugal'' Signals	597	(1)
Segmental Fields of Sensation---The Dermatomes	597	(1)
Somatic Sensations: II. Pain, Headache, and Thermal Sensations	598	(15)
Types of Pain and Their Qualities---Fast Pain and Slow Pain	598	(1)
Pain Receptors and Their Stimulation	598	(2)
Rate of Tissue Damage as a Stimulus for Pain	599	(1)
Dual Pathways for Transmission of Pain Signals into the Central Nervous System	600	(2)
Dual Pain Pathways in the Cord and Brain Stem---The Neospinothalamic Tract and the Paleospinothalamic Tract	600	(2)
Pain Suppression (``Analgesia'') System in the Brain and Spinal Cord	602	(1)
Brain's Opiate System---Endorphins and Enkephalins	602	(1)
Inhibition of Pain Transmission by Simultaneous Tactile Sensory Signals	603	(1)
Treatment of Pain by Electrical Stimulation	603	(1)
Referred Pain	603	(1)
Visceral Pain	603	(2)
Causes of True Visceral Pain	604	(1)
``Parietal Pain'' Caused by Visceral Disease	604	(1)
Localization of Visceral Pain---``Visceral'' and the ``Parietal'' Pain Transmission Pathways	604	(1)
Some Clinical Abnormalities of Pain and Other Somatic Sensations	605	(1)
Hyperalgesia	605	(1)
Herpes Zoster (Shingles)	605	(1)
Tic Douloureux	605	(1)
Brown-Sequard Syndrome	606	(1)
Headache	606	(1)
Headache of Intracranial Origin	606	(1)
Thermal Sensations	607	(6)
Thermal Receptors and Their Excitation	607	(2)
Transmission of Thermal Signals in the Nervous System	609	(4)
UNIT X The Nervous System: B. The Special Senses
The Eye: I. Optics of Vision	613	(13)
Physical Principles of Optics	613	(4)
Refraction of Light	613	(1)
Application of Refractive Principles to Lenses	613	(2)
Focal Length of a Lens	615	(1)
Formation of an Image by a Convex Lens	616	(1)
Measurement of the Refractive Power of a Lens---``Diopter''	616	(1)
Optics of the Eye	617	(5)
The Eye as a Camera	617	(1)
Mechanism of ``Accommodation''	617	(1)
Pupillary Diameter	618	(1)
Errors of Refraction	619	(2)
Visual Acuity	621	(1)
Determination of Distance of an Object from the Eye---``Depth Perception''	621	(1)
Ophthalmoscope	622	(1)
Fluid System of the Eye---Intraocular Fluid	623	(3)
Formation of Aqueous Humor by the Ciliary Body	623	(1)
Outflow of Aqueous Humor from the Eye	623	(1)
Intraocular Pressure	624	(2)
The Eye: II. Receptor and Neural Function of the Retina	626	(14)
Anatomy and Function of the Structural Elements of the Retina	626	(2)
Photochemistry of Vision	628	(4)
Rhodopsin-Retinal Visual Cycle, and Excitation of the Rods	629	(2)
Automatic Regulation of Retinal Sensitivity---Light and Dark Adaptation	631	(1)
Color Vision	632	(1)
Tricolor Mechanism of Color Detection	632	(1)
Color Blindness	633	(1)
Neural Function of the Retina	633	(7)
Neural Circuitry of the Retina	633	(3)
Ganglion Cells and Optic Nerve Fibers	636	(1)
Excitation of the Ganglion Cells	637	(3)
The Eye: III. Central Neurophysiology of Vision	640	(11)
Visual Pathways	640	(1)
Function of the Dorsal Lateral Geniculate Nucleus of the Thalamus	640	(1)
Organization and Function of the Visual Cortex	641	(2)
Layered Structure of the Primary Visual Cortex	642	(1)
Two Major Pathways for Analysis of Visual Information---(1) The Fast ``Position'' and ``Motion'' Pathway; (2) The Accurate Color Pathway	643	(1)
Neuronal Patterns of Stimulation During Analysis of the Visual Image	643	(1)
Detection of Color	644	(1)
Effect of Removing the Primary Visual Cortex	644	(1)
Fields of Vision; Perimetry	644	(1)
Eye Movements and Their Control	645	(3)
Fixation Movements of the Eyes	645	(2)
``Fusion'' of the Visual Images from the Two Eyes	647	(1)
Autonomic Control of Accommodation and Pupillary Aperture	648	(3)
Control of Accommodation (Focusing the Eyes)	649	(1)
Control of Pupillary Diameter	649	(2)
The Sense of Hearing	651	(12)
Tympanic Membrane and the Ossicular System	651	(1)
Conduction of Sound from the Tympanic Membrane to the Cochlea	651	(1)
Transmission of Sound Through Bone	652	(1)
Cochlea	652	(5)
Functional Anatomy of the Cochlea	652	(2)
Transmission of Sound Waves in the Cochlea---``Traveling Wave''	654	(1)
Function of the Organ of Corti	655	(1)
Determination of Sound Frequency---The ``Place'' Principle	656	(1)
Determination of Loudness	656	(1)
Central Auditory Mechanisms	657	(3)
Auditory Nervous Pathways	657	(1)
Function of the Cerebral Cortex in Hearing	658	(2)
Determination of the Direction from Which Sound Comes	660	(1)
Centrifugal Signals from the Central Nervous System to Lower Auditory Centers	660	(1)
Hearing Abnormalities	660	(3)
Types of Deafness	660	(3)
The Chemical Senses---Taste and Smell	663	(10)
Sense of Taste	663	(4)
Primary Sensations of Taste	663	(1)
Taste Bud and Its Function	664	(1)
Transmission of Taste Signals into the Central Nervous System	665	(1)
Taste Preference and Control of the Diet	666	(1)
Sense of Smell	667	(6)
Olfactory Membrane	667	(1)
Stimulation of the Olfactory Cells	667	(1)
Transmission of Smell Signals into the Central Nervous System	668	(5)
UNIT XI The Nervous System: C. Motor and Integrative Neurophysiology
Motor Functions of the Spinal Cord; the Cord Reflexes	673	(12)
Organization of the Spinal Cord for Motor Functions	673	(2)
Muscle Sensory Receptors---Muscle Spindles and Golgi Tendon Organs---And Their Roles in Muscle Control	675	(5)
Receptor Function of the Muscle Spindle	675	(1)
Muscle Stretch Reflex	676	(2)
Role of the Muscle Spindle in Voluntary Motor Activity	678	(1)
Clinical Applications of the Stretch Reflex	678	(1)
Golgi Tendon Reflex	679	(1)
Function of the Muscle Spindles and Golgi Tendon Organs in Conjunction with Motor Control from Higher Levels of the Brain	680	(1)
Flexor Reflex and the Withdrawal Reflexes	680	(1)
Crossed Extensor Reflex	681	(1)
Reciprocal Inhibition and Reciprocal Innervation	681	(1)
Reflexes of Posture and Locomotion	682	(1)
Postural and Locomotive Reflexes of the Cord	682	(1)
Scratch Reflex	683	(1)
Spinal Cord Reflexes That Cause Muscle Spasm	683	(1)
Autonomic Reflexes in the Spinal Cord	683	(1)
Spinal Cord Transection and Spinal Shock	684	(1)
Cortical and Brain Stem Control of Motor Function	685	(13)
Motor Cortex and Corticospinal Tract	685	(6)
Primary Motor Cortex	685	(1)
Premotor Area	686	(1)
Supplementary Motor Area	686	(1)
Some Specialized Areas of Motor Control Found in the Human Motor Cortex	686	(1)
Transmission of Signals from the Motor Cortex to the Muscles	687	(1)
Incoming Fiber Pathways to the Motor Cortex	688	(1)
Red Nucleus Serves as an Alternative Pathway for Transmitting Cortical Signals to the Spinal Cord	688	(1)
``Extrapyramidal'' System	689	(1)
Excitation of the Spinal Cord Motor Control Areas by the Primary Motor Cortex and Red Nucleus	689	(2)
Role of the Brain Stem in Controlling Motor Function	691	(1)
Support of the Body Against Gravity---Roles of the Reticular and Vestibular Nuclei	691	(1)
Vestibular Sensations and Maintenance of Equilibrium	692	(5)
Vestibular Apparatus	692	(2)
Function of the Utricle and Saccule in the Maintenance of Static Equilibrium	694	(1)
Detection of Head Rotation by the Semicircular Ducts	695	(1)
Vestibular Mechanisms for Stabilizing the Eyes	696	(1)
Other Factors Concerned with Equilibrium	696	(1)
Functions of Brain Stem Nuclei in Controlling Subconscious, Stereotyped Movements	697	(1)
Contributions of the Cerebellum and Basal Ganglia to Overall Motor Control	698	(16)
Cerebellum and Its Motor Functions	698	(9)
Anatomical Functional Areas of the Cerebellum	699	(1)
Neuronal Circuit of the Cerebellum	700	(3)
Function of the Cerebellum in Overall Motor Control	703	(3)
Clinical Abnormalities of the Cerebellum	706	(1)
Basal Ganglia---Their Motor Functions	707	(5)
Function of the Basal Ganglia In Executing Patterns of Motor Activity---The Putamen Circuit	708	(1)
Role of the Basal Ganglia for Cognitive Control of Sequences of Motor Patterns---The Caudate Circuit	709	(1)
Function of the Basal Ganglia to Change the Timing and to Scale the Intensity of Movements	709	(1)
Functions of Specific Neurotransmitter Substances in the Basal Ganglial System	710	(2)
Integration of the Many Parts of the Total Motor Control System	712	(2)
Spinal Level	712	(1)
Hindbrain Level	712	(1)
Motor Cortex Level	712	(1)
What Drives Us to Action?	713	(1)
Cerebral Cortex, Intellectual Functions of the Brain, Learning and Memory	714	(14)
Physiologic Anatomy of the Cerebral Cortex	714	(1)
Functions of Specific Cortical Areas	715	(5)
Association Areas	716	(2)
Comprehensive Interpretative Function of the Posterior Superior Temporal Lobe---``Wernicke's Area'' (a General Interpretative Area)	718	(1)
Functions of the Parieto-occipitotemporal Cortex in the Nondominant Hemisphere	719	(1)
Higher Intellectual Functions of the Prefrontal Association Areas	719	(1)
Function of the Brain in Communication---Language Input and Language Output	720	(2)
Function of the Corpus Callosum and Anterior Commissure to Transfer Thoughts, Memories, Training, and Other Information Between the Two Cerebral Hemispheres	722	(1)
Thoughts, Consciousness, and Memory	723	(5)
Memory---Roles of Synaptic Facilitation and Synaptic Inhibition	723	(1)
Short-Term Memory	724	(1)
Intermediate Long-Term Memory	724	(1)
Long-Term Memory	725	(1)
Consolidation of Memory	725	(3)
Behavioral and Motivational Mechanisms of the Brain---The Limbic System and the Hypothalamus	728	(11)
Activating-Driving Systems of the Brain	728	(3)
Control of Cerebral Activity by Continuous Excitatory Signals from the Brain Stem	728	(2)
Neurohormonal Control of Brain Activity	730	(1)
Limbic System	731	(1)
Functional Anatomy of the Limbic System; Key Position of the Hypothalamus	731	(1)
Hypothalamus, a Major Control Headquarters for the Limbic System	732	(4)
Vegetative and Endocrine Control Functions of the Hypothalamus	733	(1)
Behavioral Functions of the Hypothalamus and Associated Limbic Structures	734	(1)
``Reward'' and ``Punishment'' Function of the Limbic System	735	(1)
Importance of Reward or Punishment in Behavior	736	(1)
Specific Functions of Other Parts of the Limbic System	736	(3)
Functions of the Hippocampus	736	(1)
Functions of the Amygdala	737	(1)
Function of the Limbic Cortex	738	(1)
States of Brain Activity---Sleep, Brain Waves, Epilepsy, Psychoses	739	(9)
Sleep	739	(2)
Slow-Wave Sleep	739	(1)
REM Sleep (Paradoxical Sleep, Desynchronized Sleep)	740	(1)
Basic Theories of Sleep	740	(1)
Physiologic Effects of Sleep	741	(1)
Brain Waves	741	(2)
Origin of Brain Waves	742	(1)
Effect of Varying Levels of Cerebral Activity on the Frequency of the EEG	743	(1)
Changes in the EEG at Different Stages of Wakefulness and Sleep	743	(1)
Epilepsy	743	(2)
Grand Mal Epilepsy	743	(1)
Petit Mal Epilepsy	744	(1)
Focal Epilepsy	744	(1)
Psychotic Behavior and Dementia---Roles of Specific Neurotransmitter Systems	745	(3)
Depression and Manic-Depressive Psychoses---Decreased Activity of the Norepinephrine and Serotonin Neurotransmitter Systems	745	(1)
Schizophrenia---Possible Exaggerated Function of Part of the Dopamine System	745	(1)
Alzheimer's Disease---Amyloid Plaques and Depressed Memory	746	(2)
The Autonomic Nervous System and the Adrenal Medulla	748	(13)
General Organization of the Autonomic Nervous System	748	(2)
Physiologic Anatomy of the Sympathetic Nervous System	748	(1)
Preganglionic and Postganglionic Sympathetic Neurons	748	(2)
Physiologic Anatomy of the Parasympathetic Nervous System	750	(1)
Basic Characteristics of Sympathetic and Parasympathetic Function	750	(7)
Cholinergic and Adrenergic Fibers---Secretion of Acetylcholine or Norepinephrine	750	(2)
Receptors on the Effector Organs	752	(1)
Excitatory and Inhibitory Actions of Sympathetic and Parasympathetic Stimulation	753	(1)
Effects of Sympathetic and Parasympathetic Stimulation on Specific Organs	753	(2)
Function of the Adrenal Medullae	755	(1)
Relation of Stimulus Rate to Degree of Sympathetic and Parasympathetic Effect	756	(1)
Sympathetic and Parasympathetic ``Tone''	756	(1)
Denervation Supersensitivity of Sympathetic and Parasympathetic Organs after Denervation	756	(1)
Autonomic Reflexes	757	(1)
Stimulation of Discrete Organs in Some Instances and Mass Stimulation in Other Instances by the Sympathetic and Parasympathetic Systems	757	(2)
``Alarm'' or ``Stress'' Response of the Sympathetic Nervous System	758	(1)
Medullary, Pontine, and Mesencephalic Control of the Autonomic Nervous System	758	(1)
Pharmacology of the Autonomic Nervous System	759	(2)
Drugs That Act on Adrenergic Effector Organs---Sympathomimetic Drugs	759	(1)
Drugs That Act on Cholinergic Effector Organs	759	(1)
Drugs That Stimulate or Block Sympathetic and Parasympathetic Postganglionic Neurons	759	(2)
Cerebral Blood Flow, Cerebrospinal Fluid, and Brain Metabolism	761	(10)
Cerebral Blood Flow	761	(2)
Normal Rate of Cerebral Blood Flow	761	(1)
Regulation of Cerebral Blood Flow	761	(2)
Cerebral Microcirculation	763	(1)
Cerebral Stroke Occurs When Cerebral Blood Vessels are Blocked	763	(1)
Cerebrospinal Fluid System	763	(4)
Cushioning Function of the Cerebrospinal Fluid	763	(1)
Formation, Flow, and Absorption of Cerebrospinal Fluid	764	(1)
Cerebrospinal Fluid Pressure	765	(1)
Obstruction to Flow of Cerebrospinal Fluid Can Cause Hydrocephalus	766	(1)
Blood--Cerebrospinal Fluid and Blood-Brain Barriers	766	(1)
Brain Edema	766	(1)
Brain Metabolism	767	(4)
UNIT XII Gastrointestinal Physiology
General Principles of Gastrointestinal Function---Motility, Nervous Control, and Blood Circulation	771	(10)
General Principles of Gastrointestinal Motility	771	(2)
Physiological Anatomy of the Gastrointestinal Wall	771	(2)
Neural Control of Gastrointestinal Function---Enteric Nervous System	773	(3)
Differences Between the Myenteric and Submucosal Plexuses	774	(1)
Types of Neurotransmitters Secreted by Enteric Neurons	775	(1)
Hormonal Control of Gastrointestinal Motility	776	(1)
Functional Types of Movements in the Gastrointestinal Tract	776	(1)
Propulsive Movements---Peristalsis	776	(1)
Mixing Movements	777	(1)
Gastrointestinal Blood Flow---``Splanchnic Circulation''	777	(4)
Anatomy of the Gastrointestinal Blood Supply	778	(1)
Effect of Gut Activity and Metabolic Factors on Gastrointestinal Blood Flow	778	(1)
Nervous Control of Gastrointestinal Blood Flow	779	(2)
Propulsion and Mixing of Food in the Alimentary Tract	781	(10)
Ingestion of Food	781	(3)
Mastication (Chewing)	781	(1)
Swallowing (Deglutition)	782	(2)
Motor Functions of the Stomach	784	(2)
Storage Function of the Stomach	784	(1)
Mixing and Propulsion Of Food in the Stomach---The Basic Electrical Rhythm of the Stomach Wall	784	(1)
Stomach Emptying	785	(1)
Regulation of Stomach Emptying	785	(1)
Movements of the Small Intestine	786	(2)
Mixing Contractions (Segmentation Contractions)	786	(1)
Propulsive Movements	787	(1)
Function of the Ileocecal Valve	788	(1)
Movements of the Colon	788	(2)
Defecation	789	(1)
Other Autonomic Reflexes That Affect Bowel Activity	790	(1)
Secretory Functions of the Alimentary Tract	791	(17)
General Principles of Alimentary Tract Secretion	791	(2)
Anatomical Types of Glands	791	(1)
Basic Mechanisms of Stimulation of the Alimentary Tract Glands	791	(1)
Basic Mechanism of Secretion by Glandular Cells	791	(2)
Lubricating and Protective Properties of Mucus, and Importance of Mucus in the Gastrointestinal Tract	793	(1)
Secretion of Saliva	793	(2)
Nervous Regulation of Salivary Secretion	794	(1)
Esophageal Secretion	795
Gastric Secretion	794	(5)
Characteristics of the Gastric Secretions	794	(3)
Pyloric Glands---Secretion of Mucus and Gastrin	797	(1)
Surface Mucous Cells	797	(1)
Stimulation of Gastric Acid Secretion	797	(1)
Regulation of Pepsinogen Secretion	798	(1)
Inhibition of Gastric Secretion by Other Post-Stomach Intestinal Factors	798	(1)
Chemical Composition of Gastrin And Other Gastrointestinal Hormones	799	(1)
Pancreatic Secretion	799	(3)
Pancreatic Digestive Enzymes	799	(1)
Secretion of Bicarbonate Ions	800	(1)
Regulation of Pancreatic Secretion	800	(2)
Secretion of Bile by the Liver; Functions of the Biliary Tree	802	(3)
Physiologic Anatomy of Biliary Secretion	802	(2)
Function of Bile Salts in Fat Digestion and Absorption	804	(1)
Liver Secretion of Cholesterol and Gallstone Formation	804	(1)
Secretions of the Small Intestine	805	(1)
Secretion of Mucus by Brunner's Glands in the Duodenum	805	(1)
Secretion of Intestinal Digestive Juices by the Crypts of Lieberkuhn	805	(1)
Regulation of Small Intestine Secretion---Local Stimuli	806	(1)
Secretions of the Large Intestine	806	(2)
Digestion and Absorption in the Gastrointestinal Tract	808	(11)
Digestion of the Various Foods by Hydrolysis	808	(4)
Digestion of Carbohydrates	809	(1)
Digestion of Proteins	810	(1)
Digestion of Fats	811	(1)
Basic Principles of Gastrointestinal Absorption	812	(1)
Anatomical Basis of Absorption	812	(1)
Absorption in the Small Intestine	813	(4)
Absorption of Water	814	(1)
Absorption of Ions	814	(1)
Absorption of Nutrients	815	(2)
Absorption in the Large Intestine: Formation of Feces	817	(2)
Physiology of Gastrointestinal Disorders	819	(10)
Disorders of Swallowing and of the Esophagus	819	(1)
Disorders of the Stomach	819	(2)
Peptic Ulcer	820	(1)
Specific Causes of Peptic Ulcer in the Human Being	821	(1)
Disorders of the Small Intestine	821	(1)
Abnormal Digestion of Food in the Small Intestine---Pancreatic Failure	821	(1)
Malabsorption by the Small Intestine Mucosa---Sprue	822	(1)
Disorders of the Large Intestine	822	(1)
Constipation	822	(1)
Diarrhea	822	(1)
Paralysis of Defecation in Spinal Cord Injuries	823	(1)
General Disorders of the Gastrointestinal Tract	823	(6)
Vomiting	823	(1)
Nausea	824	(1)
Gastrointestinal Obstruction	824	(5)
UNIT XIII Metabolism and Temperature Regulation
Metabolism of Carbohydrates, and Formation of Adenosine Triphosphate	829	(11)
Release of Energy from Foods, and the Concept of ``Free Energy''	829	(1)
Role of Adenosine Triphosphate in Metabolism	829	(1)
Central Role of Glucose in Carbohydrate Metabolism	830	(1)
Transport of Glucose Through the Cell Membrane	831	(1)
Insulin Increases Facilitated Diffusion of Glucose	831	(1)
Phosphorylation of Glucose	831	(1)
Glycogen Is Stored in Liver and Muscle	831	(1)
Glycogenesis---The Process of Glycogen Formation	832	(1)
Removal of Stored Glycogen---Glycogenolysis	832	(1)
Release of Energy from the Glucose Molecule by the Glycolytic Pathway	832	(5)
Summary of ATP Formation During the Breakdown of Glucose	836	(1)
Control of Energy Release from Stored Glycogen When the Body Needs Additional Energy	836	(1)
Anaerobic Release of Energy---``Anaerobic Glycolysis''	836	(1)
Release of Energy from Glucose by the Pentose Phosphate Pathway	837	(1)
Glucose Conversion to Glycogen or Fat	838	(1)
Formation of Carbohydrates from Proteins and Fats---``Gluconeogenesis''	838	(1)
Blood Glucose	839	(1)
Lipid Metabolism	840	(12)
Transport of Lipids in the Body Fluids	840	(2)
Transport of Triglycerides and Other Lipids from the Gastrointestinal Tract by Lymph---The Chylomicrons	840	(1)
Removal of the Chylomicrons from the Blood	841	(1)
``Free Fatty Acids'' Are Transported in the Blood in Combination with Albumin	841	(1)
Lipoproteins---Their Special Function in Transporting Cholesterol and Phospholipids	841	(1)
Fat Deposits	842	(1)
Adipose Tissue	842	(1)
Liver Lipids	842	(1)
Use of Triglycerides for Energy: Formation of Adenosine Triphosphate	842	(4)
Formation of Acetoacetic Acid in the Liver and Its Transport in the Blood	844	(1)
Synthesis of Triglycerides from Carbohydrates	844	(1)
Synthesis of Triglycerides from Proteins	845	(1)
Regulation of Energy Release from Triglycerides	846	(1)
Obesity	846	(1)
Phospholipids and Cholesterol	846	(2)
Phospholipids	846	(1)
Cholesterol	847	(1)
Cellular Structural Functions of Phospholipids and Cholesterol---Especially for Membranes	848	(1)
Atheroscelerosis	848	(4)
Basic Causes of Atherosclerosis---The Roles of Cholesterol and Lipoproteins	850	(1)
Other Major Risk Factors for Atherosclerosis	850	(1)
Prevention of Atherosclerosis	850	(2)
Protein Metabolism	852	(7)
Basic Properties	852	(2)
Amino Acids	852	(2)
Transport and Storage of Amino Acids	854	(1)
Blood Amino Acids	854	(1)
Storage of Amino Acids as Proteins in the Cells	854	(1)
Functional Roles of the Plasma Proteins	855	(2)
Essential and Nonessential Amino Acids	855	(2)
Obligatory Degradation of Proteins	857	(1)
Hormonal Regulation of Protein Metabolism	857	(2)
The Liver as an Organ	859	(6)
Physiologic Anatomy of the Liver	859	(1)
Hepatic Vascular and Lymph Systems	859	(2)
Blood Flows Through the Liver from the Portal Vein and Hepatic Artery	860	(1)
The Liver Functions as a Blood Reservoir	860	(1)
The Liver Has Very High Lymph Flow	860	(1)
Regulation of Liver Mass---Regeneration	860	(1)
Hepatic Macrophage System Serves a Blood-Cleansing Function	861	(1)
Metabolic Functions of the Liver	861	(1)
Carbohydrate Metabolism	861	(1)
Fat Metabolism	861	(1)
Protein Metabolism	862	(1)
Other Metabolic Functions of the Liver	862	(1)
Measurement of Bilirubin in the Bile as a Clinical Diagnostic Tool	862	(3)
Jaundice---Excess Bilirubin in the Extracellular Fluid	863	(2)
Dietary Balances; Regulation of Feeding; Obesity and Starvation; Vitamins and Minerals	865	(16)
Energy Intake and Output Are Balanced Under Steady-State Conditions	865	(1)
Dietary Balances	865	(1)
Energy Available in Foods	865	(1)
Methods for Determining Metabolic Utilization of Proteins, Carbohydrates, and Fats	866
Regulation of Food Intake and Energy Storage	865	(7)